Preventing Avoidable Hospitalizations from Long Term Care Facilities through a Collaborative Care Model.

Abstract

Background: Avoidable hospital admissions can have a significant financial cost and impact on quality of life for Long Term Care (LTC) facility residents. The Ambulatory Care Sensitive (ACS) diagnoses of pneumonia, urinary tract infections, congestive heart failure, dehydration, and chronic obstructive pulmonary disease have been identified as the most common ACS diagnoses linked to avoidable hospitalizations from nursing homes. Methods: An evidence based practice quality improvement project supported implementation of a collaborative care model in a LTC facility on Kaua`i with the primary objective of reducing avoidable hospital admissions. The target population consisted of LTC facility residents aged 65 years and older with a participating medical doctor (MD). Phase 1 of the project began with facility staff in-services on four of the five main ACS conditions. Phase 2 focused on implementation of the collaborative care model. Outcomes: Both phase 1 and 2 had a favorable impact on reducing hospital admissions for ACS conditions. Both staff MDs perceptions and the availability of in house diagnostic testing had a significant effect on the decision to transfer to the ER. The physical presence of a nurse practitioner (NP) provided timely face-to-face primary care visits for residents in addition to support and mentoring of LTC facility staff. Conclusion: MD-NP collaboration is a significant factor in preventing hospital admissions from LTC facilities. The perception of both facility staff and MDs did reveal a variation in the decision to transfer to the ER, as did the availability of in house diagnostic testing.